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		<td class="csA803F7DA" colspan="8" style="width:233px;height:17px;text-align:left;vertical-align:top;"><nobr style="line-height:1.2">BỆNH&nbsp;VIỆN&nbsp;ĐẠI&nbsp;HỌC&nbsp;Y&nbsp;DƯỢC&nbsp;TP.HCM</nobr></td>
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		<td class="cs5EA817F2" colspan="3" rowspan="2" style="width:92px;height:22px;text-align:left;vertical-align:top;"><nobr style="line-height:1.2">Cơ&nbsp;Sở&nbsp;1</nobr></td>
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		<td class="csE5855143" colspan="7" rowspan="2" style="width:214px;height:34px;text-align:left;vertical-align:top;"><nobr style="line-height:1.2">BI&#202;N&nbsp;LAI&nbsp;THU&nbsp;TIỀN</nobr></td>
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		<td class="cs5EA817F2" colspan="6" style="width:124px;height:22px;text-align:left;vertical-align:top;"><nobr style="line-height:1.2">Họ&nbsp;T&#234;n&nbsp;Bệnh&nbsp;Nh&#226;n:</nobr></td>
		<td class="cs5EA817F2" colspan="13" style="width:461px;height:22px;text-align:left;vertical-align:top;"><nobr style="line-height:1.2">xrHoTenBN</nobr></td>
		<td class="cs5EA817F2" colspan="3" style="width:34px;height:22px;text-align:left;vertical-align:top;"><nobr style="line-height:1.2">Tuổi:</nobr></td>
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		<td class="cs5EA817F2" style="width:38px;height:22px;text-align:left;vertical-align:top;"><nobr style="line-height:1.2">Trang:</nobr></td>
		<td class="cs5EA817F2" style="width:30px;height:22px;text-align:left;vertical-align:top;"><nobr style="line-height:1.2">1/1</nobr></td>
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		<td style="width:0px;height:22px;"></td>
		<td class="cs5EA817F2" colspan="2" style="width:55px;height:22px;text-align:left;vertical-align:top;"><nobr style="line-height:1.2">Số&nbsp;Phiếu:</nobr></td>
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		<td class="cs5EA817F2" colspan="3" style="width:34px;height:22px;text-align:left;vertical-align:top;"><nobr style="line-height:1.2">Ng&#224;y:</nobr></td>
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		<td class="cs82D98BB6" colspan="9" style="width:261px;height:22px;text-align:left;vertical-align:top;"><nobr style="line-height:1.2">&nbsp;T&#234;n&nbsp;Dich&nbsp;Vụ</nobr></td>
		<td class="cs82D98BB6" colspan="3" style="width:85px;height:22px;text-align:center;vertical-align:top;"><nobr style="line-height:1.2">&nbsp;ĐVT</nobr></td>
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		<td style="width:0px;height:24px;"></td>
		<td class="cs5017E93B" style="width:27px;height:23px;text-align:center;vertical-align:top;"><!--[if lte IE 7]><div class="csF7D3565D"></div><![endif]--></td>
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		<td class="cs6E66F9D8" colspan="23" style="width:664px;height:21px;text-align:center;vertical-align:top;"><nobr style="line-height:1.2">Cộng:</nobr></td>
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		<td style="width:0px;height:18px;"></td>
		<td class="cs5EA817F2" colspan="7" rowspan="2" style="width:143px;height:22px;text-align:left;vertical-align:top;"><nobr style="line-height:1.2">Tổng&nbsp;cộng&nbsp;số&nbsp;tiền&nbsp;phải&nbsp;thu:</nobr></td>
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		<td style="width:0px;height:4px;"></td>
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		<td class="cs8BD51C12" colspan="12" style="width:279px;height:23px;text-align:left;vertical-align:top;"><nobr style="line-height:1.2">Ng&#224;y&nbsp;giời&nbsp;in:</nobr></td>
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		<td style="width:0px;height:22px;"></td>
		<td class="cs8BD51C12" colspan="4" style="width:105px;height:22px;text-align:left;vertical-align:top;"><nobr style="line-height:1.2">&nbsp;Người&nbsp;lập&nbsp;phiếu:</nobr></td>
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